Pharmacotherapy
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To assess antihypertensive treatment practices and outcomes for patients with acute severe hypertension requiring hospitalization. ⋯ Pharmacologic treatment of acute severe hypertension in patients with nonneurologic causes is heterogeneous and often not consistent with Joint National Committee recommendations. Patients received numerous intravenous agents, experienced variable decreases in SBP, often failed to receive timely oral therapy, and a clinically relevant proportion developed hypotension.
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Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare neurodegenerative disease caused by the decreased ability of cells to produce sufficient energy in the form of adenosine 5'-triphosphate. Although it is one of the most common maternally inherited mitochondrial disorders, its exact incidence is unknown. Caused most frequently by an A-to-G point mutation at the 3243 position in the mitochondrial DNA, MELAS syndrome has a broad range of clinical manifestations and a highly variable course. ⋯ Some of the most frequently prescribed agents include coenzyme Q(10), l-arginine, B vitamins, and levocarnitine. Although articles describing MELAS syndrome are available, few specifically target education for clinical pharmacists. This article will provide pharmacists with a practical resource to enhance their understanding of MELAS syndrome in order to provide safe and effective pharmaceutical care.
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Antiretroviral therapy has significantly improved the typical course of human immunodeficiency virus (HIV) infection in industrialized nations, and life expectancies associated with the infection have increased. However, infection rates have generally remained unchanged, with increases noted among certain subpopulations. The use of systemic preexposure prophylaxis for HIV infection has been proposed as an intervention to reduce the risk of disease transmission in at-risk individuals. ⋯ If efficacy is proved, use of preexposure prophylaxis faces several ethical issues. Ultimately, its success will depend on proof of cost-effectiveness. Until the many questions concerning optimal use of preexposure prophylaxis for HIV are answered, however, its use should be limited to research-related clinical investigations.
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This article is the first of a three-part series intended to enhance clinical pharmacists' understanding of methods frequently used in epidemiologic research and their applications. The basic tenets of epidemiology and uses for data derived from epidemiologic studies are given, along with a high-level overview of the differences between experimental and observational study designs. ⋯ Applications for observational studies in pharmacoepidemiology (including the case-crossover and case-time-control study designs) are discussed. Finally, points to consider when evaluating data from observational studies are addressed.
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Sepsis remains one of the leading causes of mortality in the United States. Cardiovascular compromise is one of the major contributors to the high mortality associated with sepsis. Current cardiovascular support in patients with septic shock involves fluid administration, use of catecholamines, and potentially the use of inotropes, corticosteroids, or arginine vasopressin. ⋯ Current guidelines from the Surviving Sepsis Campaign recommend arginine vasopressin 0.03 unit/minute may be added to norepinephrine with the anticipation of an effect equal to higher doses of norepinephrine alone. Many practitioners continue to utilize arginine vasopressin for patients with septic shock due to its mechanisms of benefit on pathophysiologic derangements in this disease. Clinicians must be knowledgeable about the use of arginine vasopressin in septic shock, including controversial areas where guidelines do not always provide concrete recommendations.